Tinnitus Legislation Passes House of Representatives as Part of Defense Bill

ATA is pleased to report that the House version of the National Defense Authorization Act for Fiscal Year 2011, H.R. 5136, includes two provisions of direct interest to all individuals impacted by tinnitus, particularly our nation’s veterans and military personnel. These provisions would: 1) ensure that military personnel receive pre- and post- deployment aural screening, including an assessment for tinnitus, and 2) require the Department of Defense (DoD) to study and report back with recommendations on methods to improve aural protection of its personnel.

These important provisions were offered by Rep. Mary Fallin (R-OK) as amendments to H.R. 5136 during consideration of the bill by the House Armed Services Committee, and were accepted by the Committee. The Fallin tinnitus amendments were taken from a broader bipartisan tinnitus bill introduced in early May, and sponsored by Reps. Tom Cole (R-OK) and Harry Teague (D-NM), H.R. 5203, "The Tinnitus Research for Military Health Improvement Act."

While tinnitus impacts people of all ages, it is particularly prevalent among our nation’s military personnel and veteran populations. For the 3rd consecutive year, tinnitus has been ranked the #1 service connected disability by the Department of Veterans Affairs for returning personnel from Iraq and Afghanistan. For this reason, ATA continues to work to educate Congress about tinnitus and to focus Congressional attention on increasing federal research efforts to cure tinnitus, as well as developing better mechanisms to diagnose and prevent tinnitus, which H.R. 5136 would foster.

H. R. 5136 passed the House of Representatives on May 29, 2010. The Senate’s version of the FY 2011 DoD bill, S. 3454, has not yet been considered by the full Senate. After the Senate acts on its bill, the two versions will have to be reconciled in order to arrive at a final bill that may then be signed into law by the President. While the Senate bill contains positive language providing for post deployment health assessments and neurological screening, we are pleased that the House version is much stronger because of its direct reference to tinnitus-specific assessments.

ATA appreciates Rep. Fallin’s commitment to our nation’s troops and her leadership in spearheading these provisions in H.R. 5136. We are also grateful to Rep. Cole and Rep. Teague for their respective efforts throughout this session of Congress to support broader tinnitus legislation that is currently pending in House committees.

In the coming months, ATA will continue to work to ensure that the H.R. 5136 tinnitus provisions remain in the final FY 2011 Defense bill, while also working to pass other tinnitus legislation that will move us closer to our ultimate goal – better prevention and treatment for tinnitus and ultimately a cure.

Tinnitus Research gets a BOOST from the National Institutes of Health

At the forefront of ATA's advocacy efforts, are increasing federal research budgets for tinnitus research. We are thrilled to report to you that because of ATA legislative efforts, the National Institutes of Health; specifically the National Institute on Deafness and other Communication Disorders (NIDCD) has expanded their tinnitus research portfolio significantly over the past few years.

NIDCD has gone from spending $1.5 million on tinnitus research in 2005 to $4.9 million in 2008 to $8.5 million in 2009 alone! When combined with Department of Defense funding to date, total tinnitus research funding available in the United States topped $10 million for 2009. A stellar achievement for the entire ATA community.

Tinnitus Investigation funded by the Department of Defense for the Second Consecutive Year

January 2010: For the third consecutive year, tinnitus is ranked the number-one service-connected disability for returning military personnel from Iraq and Afghanistan. As of 2009, the Department of Veterans Affairs was paying out $1.1 billion for tinnitus disability to veterans from all periods of service. At the current rate of increase, this will grow to $2.26 billion and account for over 1.5 million veterans by 2014 (click here to view and download illustrations of these increases).

Since 2005, because of ATA's outreach to Members of Congress, the amount of available tinnitus research funds in the United States has grown significantly from about $1.5 million in 2005, to $4.9 million in 2007 and topped $10 million in 2009. The efforts by the U.S. government to intervene have begun a momentum and it is imperative that we continue to ramp up research funding to ultimately cure this condition.

Congress has responded by adding tinnitus to the list of researchable conditions under the DoD’s Peer Reviewed Medical Research Program for the past two years. This program, established in 1999, was specifically created to address research needs impacting military health and readiness. In its second year of eligibility, ATA-funded researcher, Dr. Thanos Tzounopoulos has been awarded a grant in the sum of nearly $1 million dollars to continue investigations on tinnitus – an overview of his work is provided below:

The American Tinnitus Association funded Dr. Tzounopoulos’ (pictured left) pilot grant to begin his investigations on this topic area in 2008. We provided $75,000 for him to begin his studies looking at the “Cellular Mechanisms of Tinnitus” and are extremely pleased to see that the Department of Defense sees the importance and application of his work to advance the knowledge of tinnitus and progress toward a cure. Their decision making indicates that they see the importance of researching tinnitus just as our Scientific Advisory Committee and Board of Directors do.

His study is aimed at revealing the cellular and neuronal circuit mechanisms mediating the triggering of tinnitus. How does tinnitus shift from a transient condition to a life-long disorder? Neuronal connections and neuronal activity can change as a result of ongoing sensory experience. This is known as plasticity of the brain. This plasticity can lead to changes in memory or learning, compensation for loss of function and adaptation to changing demands. However, plasticity-induced changes can also cause signs and symptoms of disease. Recent studies have shown that individuals with tinnitus have increased neuronal activity in certain areas of the brain, including the auditory brainstem (the first stop of the auditory nerve). The hypothesis is that the same cellular and neuronal circuit mechanisms responsible for mediating plasticity in the auditory brainstem may also underlie tinnitus.

Tinnitus, after becoming permanent, becomes a perceptual phenomenon and its long-lasting nature involves higher-level structures (including the neocortex). Therefore, the neocortex may represent a better site to target curing tinnitus after becoming permanent. He proposes that the auditory brainstem, which represents the first stop of the auditory information in the central nervous system (CNS) and the earliest stage in the auditory CNS where synaptic plasticity occurs, represents the best target for preventing the conversion of transient tinnitus to a chronic disorder.

This technical approach is innovative and will significantly advance the fields of tinnitus research and neuroscience significantly. So far, almost all studies focused on cellular changes associated with tinnitus have been performed with extracellular recordings, where underlying mechanisms cannot be studied in great mechanistic detail. Finally, this is the first time that modern imaging techniques for circuit mapping are applied to tinnitus research.

The expected outcome is that determining the mechanisms that lead to the triggering of tinnitus will, within the next 3 years, lead to the development of drugs and therapies that can be used soon after acoustic trauma, thus preventing tinnitus from becoming permanent and irreversible. Such advancement will change the standard of care for tinnitus patients, as most current approaches are focused on the management of tinnitus after it becomes a life-long disorder. Preventing the development of chronic tinnitus with transient, well-timed therapies will also reduce the side effects of systemic medications as well as the health care costs associated with long-term medical care of tinnitus patients.

HR 2506 - The Veterans Hearing and Assessment Act

On Thursday October 1, 2009, The House Veterans Affairs Subcommittee on health considered HR 2506, the Veterans Hearing and Assessment Act at a legislative hearing. The bill, introduced and sponsored by Representative Harry Teague (D-2nd, NM), addressed the issue of tinnitus as the sole issue of the bill. The bill, if passed, would mandate the Department of Veterans Affairs (VA) conduct tinnitus screenings along with current audiological evaluations. It would also mandate that tinnitus research be conducted by all VA Centers of Excellence with the capability to do so.

ATA was asked to provide a statement for the record and also was asked to help prepare the opening remarks about the significance of this bill and why it is essential that we move forward the initiatives outlined in HR 2506. Click here to take action on HR2506.

We could not do this important work without the generosity of our members and donors. We are steadfast in our efforts to keep tinnitus on the national stage and in front of our elected decision-makers so that they can continue to address tinnitus as the important issue it is. If you support this kind of effort by ATA, please continue to enable our mission-focused work by making a contribution to ATA today.

You can read the full text of the bill online at Thomas Library of Congress by typing in HR 2506 into the field in the center of the page marked "Search Bill Summary & Status". Be sure to select “Bill Number” directly underneath the search field. There are two search options and the default is set to search by “Word/Phrase.”

Tinnitus Research Funded by the U.S. Department of Defense

For the second consecutive year, tinnitus is ranked the number-one service-connected disability for returning military personnel from the Global War on Terror. Additionally since 2001, there has been an average increase of 18% per year in the number of veterans receiving service-connected disability compensation for tinnitus. Economically speaking, this currently translates to close to $800 million dollars annually just for tinnitus disability payments to veterans and will continue to grow at 18% a year or more, if there is no intervention.

Because of recent advances in medical imaging technologies, the scientific community has been able to measure and quantify neuronal changes in the brain when tinnitus is present, particularly following noise-trauma. This breakthrough has allowed them to “see” and isolate tinnitus in the auditory pathways of the brain. This isolation has allowed researchers to conclude that tinnitus can be cured; but historically, public and private research funding dollars have been woefully inadequate at around $3.5 million a year.

Congress responded to this urgency by adding tinnitus to the list of researchable conditions under the DoD’s Peer Reviewed Medical Research Program. This program, established in 1999, was specifically created to address research needs impacting military health and readiness. Tinnitus was added as an eligible condition solely because of ATA's advocacy efforts. As a result, two exemplary tinnitus investigators have been awarded grants totaling nearly $2 million dollars to continue their investigations on tinnitus – an overview of their work is provided below:

Dr. Depireux’s study will attempt to target and reduce noise-induced tinnitus by determining the efficacy of administering both antioxidants as a preventative measure (prior to noise trauma) for hearing loss and tinnitus and steroidal intervention following noise trauma. This will help to determine why tinnitus can be mitigated with certain steroids. In 3 years, they hope to have sufficient data to analyze the best course of prevention using antioxidants, and the relative benefits of intratympanic (in the ear) vs. intravenous administration of steroids, as well as the rapidity of intervention following acute acoustic trauma. This will guide the immediate “in-theater” care.

Dr. Hinrich Staecker, University of Kansas: $1,272,460 over three years
Note: Dr. Staecker is a highly regarded tinnitus researcher and a current member of ATA’s Scientific Advisory Committee – a volunteer professional committee that performs the peer review of grant proposals at ATA and makes recommendations for funding to the ATA Board of Directors.

Dr. Staecker will attempt to regenerate sensory hair cells inside the ear. These hair cells die after noise trauma, thus causing hearing loss and triggering tinnitus. Current data suggests that the loss of sensory cells in the inner ear lead to the abnormal brain activity associated with tinnitus. By replacing the hair cells, restoration of normal brain activity and reduction of tinnitus may occur. This study will determine if hair cell replacement mitigates tinnitus and if it restores normal brain activity to the hearing centers of the brain. This study will represent the first investigation of the effects of hair cell regeneration in the brain.

Advocacy

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Consumer advocates and ATA Board Members, Scott C. Mitchell, J.D., (pictured above) and Jim Chinnis, Ph.D., (pictured below) participated in the evaluation of research proposals submitted to the Peer Reviewed Medical Research Program (PRMRP) sponsored by the Department of Defense (DoD). Commenting on his role as a consumer reviewier, Dr. Chinnis noted, "This program has resulted in a number of proposals that would have been impossible to conduct even just a few years ago. The quality and focus of several proposals were well above that of even the most insightful past proposals, helping to put tinnitus research into the front ranks of medical research."